Studies of AKI outcomes
| Study and Publication Year | Study Design | Criteria | Sample Size | Mortality, Stage 1 (AKIN, KDIGO), or Risk (RIFLE) (95% CI) | Mortality, Stage 2 (AKIN, KDIGO), or Injury (RIFLE) (95% CI) | Mortality, Stage 3 (AKIN, KDIGO), or Failure (RIFLE) (95% CI) | Study Population | End Point | Summary of Findings |
|---|---|---|---|---|---|---|---|---|---|
| Mortality | |||||||||
| Ostermann and Chang (23) | Retrospective | RIFLE | 41,972 | IR 20.9%a | IR 45.6% a | IR 56.8%a | |||
| Hoste et al. (25) | Retrospective | RIFLE | 5383 | IR 8.8%a | IR 11.4%a | IR 26.3%a | |||
| Bagshaw et al. | Retrospective | RIFLE | 120,123 | IR 17.9%a | IR 27.7%a | IR 33.2%a | |||
| Lopes et al. | Retrospective | RIFLE | 182 | IR 27.3%a | IR 28.6%a | IR 55.0%a | |||
| Thakar et al. (29) | Retrospective | AKIN | 325,395 | OR 2.2 (2.17 to 2.30)b | OR 6.1 (5.74 to 6.44)b | OR 8.6 (8.07 to 9.15)b | |||
| Nisula et al. (11) | Prospective | AKIN, KDIGO | 2901 | IR 29.3% (25.2 to 33.3)b | IR 34.1% (27.8 to 40.3)b | IR 39.0% (34.3 to 43.8)b | |||
| Hoste et al. (27) | Prospective | KDIGO | 1802 | OR 1.7 (0.9 to 3.2)b | OR 3.0 (1.4 to 6.3)b | OR 6.9a (3.9 to 12.2)b | |||
| Long-term outcomes | |||||||||
| Coca et al. 2012 (36) | Systematic review and meta-analysis | RIFLE, AKIN | 1,455,418 | Hospitalized and nonhospitalized patients with and without AKI | CKD, kidney failure, and death | AKI associated with higher risk of incident CKD (pooled aHR 8.8; 95% CI, 3.1 to 25.5), kidney failure (pooled aHR 3.1; 95% CI, 1.9 to 5.0), and mortality (pooled aHR 2.0; 95% CI, 1.3 to 3.1) Graded association with AKI severity and risk of CKD or kidney failure | |||
| Bansal et al. 2018 (38) | Retrospective | KDIGO | 150,434 matched pairs | Hospitalized adult veterans with and without AKI | Incident heart failure within 2 yr postdischarge | AKI associated with higher risk of incident heart failure (HR 1.23; 95% CI, 1.19 to 1.27) | |||
| Go et al. 2018 (39) | Retrospective | KDIGO | 146,941 (31,245 with AKI) | Hospitalized adults with and without AKI | Heart failure, acute coronary syndromes, peripheral arterial disease, ischemic stroke events (up to 1 yr postdischarge) | AKI associated with higher risk of composite outcome of hospitalization for heart failure and atherosclerotic events (aHR 1.18; 95% CI, 1.13 to 1.25) Composite outcome driven by excess risk of subsequent heart failure (aHR 1.44; 95% CI, 1.33 to 1.56) Association with subsequent atherosclerotic events was nonsignificant (aHR 1.05; 95% CI, 0.98 to 1.12) | |||
| Abdel-Kader et al. 2018 (40) | Secondary analysis of prospective cohort study | KDIGO | 1317 | Critically ill adults with respiratory failure and/or shock | Clinical frailty status at 3 and 12 mo postdischarge | In adjusted models, AKI stages 1, 2, and 3 associated with higher frailty scores at 3 mo (OR 1.92; 95% CI, 1.14 to 3.24; OR 2.40; 95% CI, 1.31 to 4.42; OR 4.41; 95% CI, 2.20 to 8.82, respectively) Similar association between AKI stage and frailty scores at 12 mo (OR 1.87; 95% CI, 1.11 to 3.14; OR 1.81; 95% CI, 0.94 to 3.48; OR 2.76; 95% CI, 1.34 to 5.66, respectively) | |||
| See et al. 2019 (115) | Systematic review and meta-analysis | RIFLE, AKIN, KDIGO, VARC, VARC-2 | 2,017,437 | Hospitalized adults with and without AKI | New or progressive CKD, kidney failure, death | AKI was associated with higher risk of new or progressive CKD (HR 2.67; 95% CI, 1.99 to 3.58), kidney failure (HR 4.81; 95% CI, 3.04 to 7.62), and death (HR 1.80; 95% CI, 1.61 to 2.02) | |||
| Ikizler et al. 2021 (37) | Prospective observational multicenter | KDIGO | 1538769 with AKI (+769 non-AKI matched) | Hospitalized adults with and without AKI | Incident CKD, CKD progression, heart failure events, major atherosclerotic cardiovascular events, all-cause mortality Mean follow-up 4.5 yr (±1.8 yr) | AKI associated with higher adjusted rates of incident CKD (aHR 3.98; 95% CI, 2.51 to 6.31), CKD progression (aHR 2.37; 95% CI, 1.28 to 4.39), heart failure events (aHR 1.68; 95% CI, 1.22 to 2.31), all-cause mortality (aHR 1.78; 95% CI, 1.24 to 2.56) Risks of heart failure events and mortality nonsignificant when accounting for degree of kidney function recovery and proteinuria at 3 mo | |||
AKIN, Acute Kidney Injury Network; KDIGO, Kidney Disease Improving Global Outcomes; RIFLE, Risk, Assessment, Failure, Loss, and End Stage Renal Disease; 95% CI, 95% confidence interval; IR, incidence rate; OR, odds ratio; aHR, adjusted hazard ratio; HR, hazard ratio; VARC, Valve Academic Research Consortium; VARC-2, Valve Academic Research Consortium–2.
↵a Hospital mortality.
↵b 90-d mortality rate.